Descriptive characterization of the 2010 cholera outbreak in Nigeria

Abstract

BackgroundIn 2010, 18 States of Nigeria reported cholera outbreaks with a total of 41,787 cases including 1,716 deaths (case-fatality rate [CFR]: 4.1%). This exceeded the mean overall CFR of 2.4% reported in Africa from 2000–2005 and the WHO acceptable rate of 1%. We conducted a descriptive analysis of the 2010 cholera outbreak to determine its epidemiological and spatio-temporal characteristics.MethodsWe conducted retrospective analysis of line lists obtained from 10 of the 18 states that submitted line lists to the Federal Ministry of Health (FMOH). We described the outbreak by time, place and person and calculated the attack rates by state as well as the age- and sex-specific CFR from cholera cases for whom information on age, sex, place of residence, onset of symptoms and outcome were available.ResultsA total of 21,111 cases were reported with an overall attack rate and CFR of 47.8 cases /100,000 population and 5.1%, respectively. The CFR ranged in the states between 3.8% and 8.9%. The age-specific CFR was highest among individuals 65 years and above (14.6%). The epidemiological curve showed three peaks with increasing number of weekly reported cases. A geographical clustering of LGAs reporting cholera cases could be seen in all ten states. During the third peak which coincided with flooding in five states the majority of newly affected LGAs were situated next to LGAs with previously reported cholera cases, only few isolated outbreaks were seen.ConclusionOur study showed a cholera outbreak that grew in magnitude and spread to involve the whole northern part of the country. It also highlights challenges of suboptimal surveillance and response in developing countries as well as potential endemicity of cholera in the northern part of Nigeria. There is the need for a harmonized, coordinated approach to cholera outbreaks through effective surveillance and response with emphasis on training and motivating front line health workers towards timely detection, reporting and response. Findings from the report should be interpreted with caution due to the high number of cases with incomplete information, and lack of data from eight states.

Characterization of Vibrio cholerae Strains Isolated from the Nigerian Cholera Outbreak in 2010

“…Cholera outbreaks can be observed almost annually in Nigeria (1), including a large outbreak in 2013 and 2014 (2), and it is well known that the disease is dependent on climate and socioeconomic factors (3). The cholera epidemic in Nigeria in 2010, with 41,787 reported cases and a case fatality rate (CFR) of 4.1%, was one of the largest outbreaks in Africa, with 80% of reported cases attributed to women and children (4,5). The vast majority of strains associated with epidemic cholera are attributed to the V. cholerae O:1 and O:139 serogroups, producing the cholera toxin (CT) (6).…”

Cholera in Internally Displaced Persons Camps in Borno State—Nigeria, 2017: A qualitative study of the multi-sectorial emergency response to stop the spread of the outbreak

“…Overall, case management response was appropriate as ORPs where setup in hard-to-reach areas to treat less severe cases and referred severe ones to CTUs/CTCs. It achieved a 1.14% CFR, the lowest in Borno ever since outbreaks were measured [4]. Still, this is considered high as it is not below 1% as recommended by WHO [11].…”

“…Between 1991 and 2018 a total of 321,148 cases and 18,644 deaths with 5.8% case fatality ratio (CFR) were reported across Nigeria [2, 3]. In 2010, Local Government Areas (LGAs) in Borno State (Fig 1A) reported an outbreak that grew in magnitude and spread to include 21,111 cases (CFR 5.1%) [4]. In August 2017, another cholera outbreak started in Borno State in the Muna Garage camp for Internally Displaced Persons (IDP) camp in Jere LGA (Fig 1B).…”

What are the drivers of recurrent cholera transmission in Nigeria? Evidence from a scoping review

“…A 2-fold increase in cholera cases with a 1°C increase in temperature at 4 months lag has been reported in Zanzibar [69], indicating the importance of temperature in cholera transmission. Flooding was also identified as an environmental driver of cholera transmission in Nigeria [41,70]. Flooding increases cholera transmission by (1) disrupting access to or contaminating safe water sources; (2) affecting sanitation conditions; and (3) limiting access to essential health services [71][72][73].…”